Resus of the hypotensive patient Part 1 - When IV Fluids Kill

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There is probably no other drug emergency providers administer more often than IV fluids.  We give them to patients with mild heat exhaustion, gastroenteritis and orthostatic dizziness to name a few.  These patients tend to feel better, go home and no harm comes to them.  However, for the subset of patients with shock and potential recipients of large volume resuscitation, excessive IV fluids can harm.  In part one of this two part series, Dr. Mackenzie discusses how IV fluids can lead to increased renal injury, pulmonary edema, and extra-vascular lung water.    

 

 

Take away Points

1.     Unnecessary IV fluid increases mortality and kidney injury in the critically ill.

2.     Most patients with septic shock do not have profound volume depletion but an increase in unstressed venous volume.

3.     Cardiac output can be increased with vasopressor infusions without exposing patients to the harms of IV fluid.

 
 
Mackenzie IV fluids figure 1.jpg
 
 
 
Mackenzie IV fluids figure 2.jpg
 
 

For more on this subject, check out this great post on EMCrit on Fluids in sepsis: a new paradigm

 

Recorded at the Maine Medical Center Winter Symposium in 2017

David Mackenzie, MDCM, FRCPC, FACEP

Assistant Professor of Emergency Medicine
Maine Medical Center
Tufts University School of Medicine

 

References

1. Marik PE, Bellomo R. A rational approach to fluid therapy in sepsis. Br J Anaesth .2016; 116(3): 339-49.

2. Vincent JL, Sakr Y, Sprung CL et al. Sepsis in European intensive care units. Crit Care Med. 2006; 34(2): 344-53.

3. Boyd JH, Forbes J, Nakada T, Walley KR, Russell  JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure increase mortality. Crit Care Med. 2011; 39:25-65.